title: Effects of pre-pregnancy obesity, race/ethnicity and prematurity.
abstract: To investigate the association between maternal pre-pregnancy obesity, race/ethnicity and prematurity. Retrospective cohort study of maternal deliveries at a single regional center from 2009 to 2010 time period (n = 11,711). Generalized linear models were used for the analysis to estimate an adjusted odds ratio with 95% confidence interval of the association between maternal pre-pregnancy obesity, race/ethnicity and prematurity. Analysis controlled for diabetes, chronic hypertension, previous preterm birth, smoking and insurance status. The demographics of the study population were as follows, race/ethnicity had predominance in the White/Non-Hispanic population with 60.1%, followed by the Black/Non-Hispanic population 24.2%, the Hispanic population with 10.3% and the Asian population with 5.4%. Maternal pre-pregnancy weight showed that the population with a normal body mass index (BMI) was 49.4%, followed by the population being overweight with 26.2%, and last, the population which was obese with 24.4%. Maternal obesity increased the odds of prematurity in the White/Non-Hispanic, Hispanic and Asian population (aOR 1.40, CI 1.12-1.75; aOR 2.20, CI 1.23-3.95; aOR 3.07, CI 1.16-8.13, respectively). Although the Black/Non-Hispanic population prematurity rate remains higher than the other race/ethnicity populations, the Black/Non-Hispanic population did not have an increased odds of prematurity in obese mothers (OR 0.87; CI 0.68-1.19). Unlike White/Non-Hispanic, Asian and Hispanic mothers, normal pre-pregnancy BMI in Black/Non-Hispanic mothers was not associated with lower odds for prematurity. The odds for mothers of the White/Non-Hispanic, Hispanic and Asian populations, for delivering a premature infant, were significantly increased when obese. Analysis controlled for chronic hypertension, diabetes, insurance status, prior preterm birth and smoking. Obesity is a risk factor for prematurity in the White/Non-Hispanic, Asian and Hispanic population, but not for the Black/Non-Hispanic population. The design and evaluation of weight-based maternal health programs that aggregate race/ethnicity may not be sufficient. The optimal method to address maternal pre-pregnancy and intra-pregnancy weight-related health disorders may need to be stratified along race/ethnicity adjusted strategies and goals. However, a more global preventative strategy that encompasses the social determinants of health may be needed to reduce the higher rates of prematurity among the Black/Non-Hispanic population.
authors.affiliation: Department of Neonatal-Perinatal Medicine, St. Christopher's Hospital for Children, Philadelphia, PA, USA, bedejongh@gmail.com.
authors.forename: B E
authors.initials: BE
authors.lastname: de Jongh
authors.forename: D A
authors.initials: DA
authors.lastname: Paul
authors.forename: M
authors.initials: M
authors.lastname: Hoffman
authors.forename: R
authors.initials: R
authors.lastname: Locke
mesh_terms: D000328:Adult; D044383:Black People; D015992:Body Mass Index; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D016014:Linear Models; D009765:Obesity / Q000150:complications* / Q000208:ethnology*; D016017:Odds Ratio; D011247:Pregnancy; D011248:Pregnancy Complications / Q000208:ethnology*; D047928:Premature Birth / Q000208:ethnology / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D044465:White People; D055815:Young Adult